![]() Brexanolone’s most common adverse reactions include dry mouth, flushing, loss of consciousness, and sleepiness. Clinical trials identified some serious risks, including excessive sedation or sudden loss of consciousness during administration, so brexanolone has a risk evaluation and mitigation strategy: Patients must receive treatment at a certified health care facility under close monitoring during the 60-hour infusion, patients must have continuous pulse oximetry and patients may see their children only under direct supervision. Brexanolone acts as a positive allosteric modulator at those receptors. In PPD, gamma-aminobutyric acid-A receptors become dysregulated. Brexanolone is chemically identical to endogenous allopregnanolone, a hormone that falls after childbirth. In March 2019, the FDA approved the first drug specifically for PPD. Clinicians can consider other antidepressants if first-line antidepressant medications are ineffective or tolerated poorly. Generally, treatment starts with a selective serotonin reuptake inhibitor (SSRI) or a serotonin/norepinephrine reuptake inhibitor administered at the same doses used for others who have depression. When the clinician and patient decide that medication is needed, treatment follows a pattern similar to that used in other kinds of depression (figure 4 ). For these women, nonpharmacologic strategies are very important. Pharmacists should note that some new mothers are breastfeeding and may be hesitant to take medication. These include group or individual psychotherapy and psychoeducational support groups. 16Įarly treatment is crucial and starts with nonpharmacologic strategies in women with mild to moderate depressive symptoms. 15 Affected individuals may also have ambivalent feelings, obsess about the baby, or think about hurting her children or herself. As with other kinds of depression, symptoms occur along a continuum. PPD manifests as anhedonia, appetite disturbance, depressed mood, fatigue, insomnia, recurring thoughts of death, suicidal thoughts, and tearfulness. Conversely, PPD is persistent and interferes with the mother’s ability to care for herself and others and may not resolve spontaneously. Generally, these symptoms spontaneously diminish over 2 weeks. Postpartum blues-anxiety, fluctuating mood, irritability, and tearfulness-are real and tend to develop around the fourth or fifth day postpartum in about half of women. 4,14 Sadly, many women do not seek prompt treatment, thinking they are just tired or finding other excuses, such as “it’s just postpartum blues.” In addition, tremendous stigma accompanies this condition. 12,13 Symptoms can last 1 year or longer, with 25% of women having symptoms at 1 year. Subject matter experts indicate that biologic, hormonal, and psychosocial issues are risk factors for postpartum mood disorders (table 5-11). 1 Among those women, about 15% will have a disabling, persistent condition, and a small percentage will develop postpartum psychosis. ![]() ![]() Recent discoveries concerning PPD’s pathophysiology offer tremendous hope to the approximately 400,000 women who develop it annually in the United States. ![]() Maternal postpartum depression (PPD), although common, disabling, and sometimes life-threatening, often remains undiagnosed and undertreated. ![]()
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